Less volume, excess skin, saggy 2.5 years post BBL. Would an autologous butt lift without fat transfer be the best fix? (Photos)

Question

I had a bbl 2.5 years ago now i have less volume and excess skin. I was going to try excercise but seems that wont cure the problem whats my solution ? I was advised autologous butt lift without fat transfer ?? Thanks

J. Timothy Katzen, MD, FACS · Answer

Hello Generous20224 in Nottingham, J8, Thank you for your question regarding less volume, excess skin, and saggy 2.5 years post BBL, and would an autologous butt lift without fat transfer be the best fix? Thank you for the history and pictures. Let’s analyze your picture. You have mild cutis pleonasmus (excess skin) and dermatocholosis (loose skin) of your buttocks. You do not have lipodystrophy (excess fat) in your buttocks. Your buttock shape looks good; it's just the extra skin in the middle and bottom third of your buttocks. The only way to remove excess buttock skin is with an incision. There are many types of butt lifts. However, for you, based on your pictures, most plastic surgeons would recommend a superior (little M or seagull) posterior buttock lift. The crescent or infra-gluteal roll approach will not work because it will only pull the buttock down and flatten the buttock. Furthermore, the Miami thong lift (in the crease) will not significantly raise the lower buttock.  
A butt lift, also called a buttock lift or posterior body lift, is a surgical procedure designed to remove excess skin and tissue from the upper buttocks, lower back, hips, and occasionally the outer thighs to create a smoother, tighter, and more youthful lower-body contour. A butt lift is performed under general anesthesia and typically takes approximately 3 to 4 hours, depending on the amount of excess skin and whether additional procedures are performed at the same time. The incision generally extends from the top of the gluteal cleft (butt crack), across the upper buttocks, and toward the hips, creating a curved shape that may resemble a butterfly, seagull, small “M,” or what some patients call a “McDonald’s incision.” Through this incision, the skin and underlying tissues are carefully dissected and elevated, and excess skin is removed to lift and tighten the buttocks, similar to the posterior portion of a 360-degree circumferential lower body lift. If excess skin extends toward the hips or outer thighs, the butt lift incision can be extended laterally to improve the overall contour. If you also have significant excess abdominal skin, the butt lift can be combined with an abdominoplasty (tummy tuck); when the incision extends around the sides and connects to the front of the abdomen, the procedure is commonly referred to as a 360 lower body lift or circumferential body lift. A 360 lower body lift can address excess skin around the abdomen, flanks, hips, lower back, buttocks, and outer thighs and is particularly beneficial for many patients following massive weight loss. Plan for approximately 3 to 4 weeks of recovery after a butt lift, although individual recovery varies. During the early healing period, it is important to protect the incision by spending significant time lying on your abdomen and avoiding prolonged sitting directly on the surgical area, excessive bending, stretching, or activities that place tension on the incision, as these can increase the risk of wound separation and delayed healing. Your plastic surgeon will provide specific instructions regarding sleeping position, walking, sitting, exercise, compression garments, wound care, and return to normal activities. A butt lift is primarily a skin and soft-tissue lifting procedure and is different from a Brazilian butt lift (BBL), which uses fat transfer to increase buttock volume. The ideal procedure depends on the location and amount of excess skin, your body proportions, weight stability, previous surgeries, and aesthetic goals; some patients require only a posterior buttock lift, while others benefit from extension toward the hips or combination with a tummy tuck as part of a 360 lower body lift. I hope that I have answered your question regarding a butt lift. If you have any more questions regarding a posterior buttock lift, contact an experienced plastic surgeon. Please seek an experienced, board-certified plastic surgeon with significant experience in butt lifts. Make sure they have performed many buttock lift surgeries and have the before-and-after  pictures to prove it. Carefully examine their before-and-after pictures on RealSelf. If you cannot find an experienced, plastic surgeon in your neighborhood, consider traveling. Sincerely, Dr. Katzen (Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Ryan A. Stanton, MD · Answer

Allow me to answer your question as best i can based upon your photos. However, please keep in mind that an in-person, or at least a virtual, consultation with physical exam is first necessary before any legitimate evaluation or final surgical recommendations can be made.

Buttock “sagging” and/or loose skin is usually a combination of loss of volume or deflation (after weight loss, liposuction, or post-BBL) and/or the effect of aging and gravity. So,  I personally first treat patients like you by restoring volume to the buttock with a buttock implant. This will create a more desirable smooth and rounded perky buttock profile. If not adding volume with an implant, the buttock will most certainly always appear more flat if just a buttock lift from above is performed. On the other hand, an “autologous buttock lift” usually provides very little volume and projection, and almost nothing to the lower 2/3rds of the buttock.

A lower buttock tuck is usually then performed at six months following implants. Coincidentally, a lower buttock tuck also doubles as a thigh lift, removing loose wrinkled skin from this area as well. In this sequence, the implants have fully settled into final position so that any remaining loose skin can be most accurately identified and removed with the lower buttock tuck. Any “non-surgical” treatment or device as well as exercise, unfortunately, will have little to no effect on this problem area. Furthermore, fat transfer and “fillers” perform very poorly in this area and usually result in just a waste of hard earned money.

Please note, because an extremely few number of board certified plastic surgeons specialize in buttock implants, you may have to travel away from your local area to seek consultation with this particular type of surgeon.  Getting it done right the first time around is not only the best chance for success, but also will save you from a lot of headaches and money in the future. Glad to help.

Mats Hagstrom, MD (license on probation) · Answer

To make a quality assessment, we need quality information.Bad previous surgery in this area then you should include before and after pictures.If you don’t have before, and after pictures and ask your surgeon to forward the pictures they took.A second round of transfer is most likely going to be your best option.There is no effective treatment for skin laxity other than skin surgery, which works better in some areas than others.To assess for a second round of transfer, we need to assess in regards to both Liposuction and transfer.I recommend you’re like exclusively on in person consultations.Best,Mats Hagstrom MD

Less volume, excess skin, saggy 2.5 years post BBL. Would an autologous butt lift without fat transfer be the best fix? (Photos)

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